what can we do more for the cost-effectiveness of management of aki? 鄭昌錡 20120321 1
TRANSCRIPT
What can we do more for the cost-effectiveness of management of
AKI?鄭昌錡
20120321
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Siew ED, et al. JASN 2011
Phases of clinical Phases of clinical biomarker evaluation biomarker evaluation and AKI studies and AKI studies
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The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, or to improve the delivery of care.
Definition
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Guise JM and Viswanathan M, Clinical pharmacology & Therapeutics 90, 876 (2011)
StandardTreatment
Alternative
Clone 1
Clone 2
C2
C1
Decision Tree
Probability 1
p1
p2
AVERAGE OUTCOMES
Life years (LY), QALY,…
Average costs
Outcome2
Probability 2
Clone 1
Probability 1
Clone 2
Probability 2
C2
C1
p1
p2
OutcomeOutcome11
Outcome2
Outcome1Outcome1
OutcomeOutcome11
Outcome2
Outcome2
Outcome2
Outcome2
OutcomeOutcome11
OutcomeOutcome11
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StandardTreatment
Alternative
Clone 1
BioSignatureBioSignature
Clone 1
Probability 1
Clone 2
Probability 2
C2
p1
p2
OutcmeOutcme11
Outcome2
OutcmeOutcme11
Clone 2
C2
C1Probability 1
p1
p2Outcome2
Probability 2
OutcmeOutcme11
BIOMARKERSBIOMARKERS
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Novel biomarkers in AKI
Parikh CR et al. CCM 2008Chen YC, Fang JT, Yang CW. Taiwan Crit Care Med 2009
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CCU
AMI
(n>1000)
Non-AMI
Cardiac enzymesCXRECG
AHF
Non-HF
Non-HF
AHF
Mortality
Survive
Survive
Apply into Cardiorenal syndrome
BNPPro-BNPCardiac echo
BNPPro-BNPCardiac echo
AKI biomarkersAKI biomarkers
AKI biomarkersAKI biomarkers
AKI
AKI
Non-AKI
Non-AKI
SMT
Survive
Mortality
Survive
Mortality
Intervention
SMT
Recovery
Recovery
Recovery
Recovery
Mortality
Mortality
Mortality
Mortality
CKD
CKD
CKD
CKD
ESRD on RRT
ESRD on RRT
ESRD on RRT
ESRD on RRT
PS. AKI patients >300, Mortality patients >90
Mortality
Intervention
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